[The overlooked chin trauma in children]

Children seldom experience major facial trauma. However, minor injuries such as facial lacerations, abrasions and dental trauma are more common and naturally get less attention. Children with TMJ trauma usually present with pain, limited jaw movement and even malocclusion. However, these findings are not always recognized and sometimes get overlooked when chin laceration is the only sign. Plain x-rays can contribute to the diagnosis but in many cases are inconclusive and are difficult to interpret. Often, there is a diagnostic dilemma, especially when the clinical findings are not clear and normal occlusion is hard to restore. We present 3 out of 12 children in whom we diagnosed condylar head fracture following minor facial trauma. All children had normal physiological occlusion. Most of them had mild clinical signs such as limited mouth opening, pain and tenderness upon palpation of the joint. Routine plain films were not conclusive. The diagnosis was made or confirmed with CT scan. Early diagnosis of TMJ fracture in children is mandatory for the prevention of long term functional and esthetically debilitating sequela.

A thorough clinical examination and normal occlusion do not rule out condylar head fracture after chin trauma. Plain films are of limited value in the diagnosis of such fractures. CT should be considered for the evaluation of these children.